This inspection took place on the 9 November 2016 and was unannounced.

Oxlip House provides personal care and with a designated team of carers based within a housing with care scheme with 52 self-contained flats. On the day of our inspection there were 32 people receiving personal care support.

There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection in July 2014 we found the provider did not always protect people against the risks associated with the unsafe management of their medicines.

At this inspection whilst we found some improvements had been made, we identified a continued breach in relation to the management of people’s medicines. However, in response to our findings, and within 24 hours the provider took immediate action to rectify the shortfalls we identified. This included swift action to review and update the provider’s medicines management policy to reflect national guidance and include vital information within management audit tools. These were distributed to other scheme manager’s throughout the organisation.

People’s safety had been considered and they were at a reduced risk of harm as staff understood their roles and responsibilities in relation to action they should take to safeguard people from the risk of abuse. Training staff received supported them to have the required knowledge and procedural guidance as to the action they should take in reporting to the appropriate authorities, should they suspect people were at risk of being harmed.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff received training, supervision and support to provide them with the knowledge and skills they needed to meet the needs of people living at the service. Training included supporting staff to understand their roles and responsibilities with regards to the Mental Capacity Act 2005. This meant staff understood the legal requirements to seek consent and provide care and treatment in a manner which protected and upheld people’s human rights.

Staff were provided with regular supervision and annual appraisals. This enabled staff to be supported and provided with opportunities to discuss their work performance and plan their training and development needs. The manager had systems in place to carry out spot checks on staff performance and in assessing the quality and safety monitoring of the service. The manager followed safe recruitment practices with steps taken to assess that staff employed were of good character, competent and had the necessary skills for the work they performed.

People were satisfied with the care provided. Everyone we spoke with expressed their satisfaction with the way the service was managed and the support provided by staff. People told us they felt safe and were treated with kindness and compassion. They also told us their dignity had been respected when staff supported them with personal care and their independence encouraged.

The care needs of people had been assessed prior to their moving into the service. Risks to people’s health and wellbeing were clearly identified and actions in place to minimise these.

People were provided with opportunities to express their views regarding the quality of the service. Regular meetings were held and their views regularly surveyed. People were knowledgeable about the provider’s system for receiving and responding to complaints.

The culture of the service was open, transparent and focused on the needs of people who live at Oxlip House. Staff were supported by the manager who they described as supportive and approachable. The quality and safety of the service was m

We carried out this inspection under Section 60 of the Health and Social Care Act 2012 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service.

The inspection was unannounced.

Our last inspection was carried out on the 17 and 18 July 2013. We found that there were no breaches with regulatory requirements in the areas that we looked at.

At the time of our inspection a registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Oxlip House provides housing with domiciliary care support from a designated team of carers based within the housing scheme for people living within 52 flats.

People told us there were enough staff available to meet their personal care needs. They also told us that carers arrived on time and the timing of calls suited their needs and preferences.

We reviewed the management of people’s medicines. The provider did not always protect people against the risks associated with the unsafe management of their medicines. Quality monitoring audits were ineffective in identifying medication errors. Not all staff had been trained in the safe handling of people’s medicines.

People told us they felt safe, that the staff were kind, caring and respectful and that they met their needs. Our observations confirmed this. Staff knocked on people’s doors and waited for an answer before they entered their flat. Staff treated people with respect and were kind and compassionate in their approach towards them. People also told us that they found the staff and the registered manager approachable and available to speak to when they were concerned about anything.

The registered manager investigated and responded to people’s complaints, in accordance with the provider’s complaints procedure.

People’s needs had been assessed when they first started to use the service. Information was obtained about people’s health and welfare needs. People received support that met their current care needs because their support was regularly reviewed to ensure it was effective.

Comments received from questionnaires we sent health and social care professionals were positive about the support provided at Oxlip House. One commented, “They provide a very good service, we have no concerns.” Relatives told us staff were, “excellent, very professional.” Another said, “They are all very caring”.

We found that that regulations related to the management of people’s medicines was not being fully met. You can see what action we told the provider to take at the back of the full version of the report.

This routine inspection examined two outcomes of care and welfare and medication management. We found the service complaint in both outcomes.

People who use the service were very pleased with the way they were supported. One person said, “The carers here are really lovely. The carers are very good to me and know what to do.” Another person told us how approachable the new manager was and was pleased with the changes that had been made. We spoke with two staff members and they were pleased that they had a full staff compliment and a manager that solves problems as they arose.

We spoke with five people who use the service and all were satisfied with the call bell system, secure front door and the telephone system used in Oxlip House. One person told us “The emergency call bell does work very well. I have personal experience of an emergency and it works brilliantly”.

One person told us “The carers couldn’t be more caring. I’m satisfied. I was ill and they responded fantastically good”. Another person told us “I’m happy with the support and care I get, but I would like to get out more into town”.

One person told us “The balance of agency staff to regular staff was out of balance. It is now changing as they are recruiting more staff”. Another person told us “Most of the staff are good. Occasionally I have to wait if they are short staffed; mostly they are on time for my scheduled visit”.

Oxlip House is a newly built building consisting of 52 apartments, which can be part owned or rented. It is a joint venture between Bedford Pilgrims Housing Association (BPHA) and The Orders of St John Care Trust (OSJCT).

The BPHA developed the building , will maintain it and provide the sales service. The OSJCT will manage the accommodation and provide the very sheltered, extra care service. The Orders of St John Care Trust is registered with us at this location, as a domiciliary care agency. They work within the restraints of agreed care packages, drawn up with each individual based on their care needs. Everyone who lives in one of the apartments are contracted to buy a minimum number of care hours from the care agency, three hours a week for those with a shared ownership and four hours a week for those renting. This may involve complex care packages or simply shopping and cleaning.

Extra care housing is designed to provide accommodation with a care agency based in the same location so that the care they provide, within a care package, can be flexible and available 24-hours a day.

During our visits to Oxlip House, we spoke to the majority of the people living in the apartments. They had many concerns about various elements of the service they were provided with.

Some of the concerns involved the way the apartments were sold to people. The care agency was not involved in the sale of the apartments and so we were not able to comment on this aspect of people’s worries.

People also had concerns about some of the services provided within the building, for example the call bell system, the phone exchange, the way staff communicated with each other and how entry into the building was managed. These areas did have an impact on the quality of care people received, but were not strictly speaking the responsibility of the care agency as these facilities were installed to the specification of the developers and the Orders of St John Care Trust were not consulted on their functionality beforehand. However, because of the detrimental impact they were having on people, the agency have undertaken to negotiate with the manufacturer to improve their effectiveness.

Some of the people we spoke with told us that they thought that they were moving into a care home. They were disappointed to find out that that the support they would receive from the care staff would be constrained by the contracted hours they had agreed to pay for or had been allocated within a care package drawn up by the local authority.

The agency provided 24-hour care, but only to those people who have been assessed as needing 24-hour care as part of their care package or have agreed to pay for that facility. The care staff will respond if people need emergency assistance outside their contracted hours but, unlike a care home, they are unable to do favours and carryout non-care related tasks outside people’s care visits.

People using the agency also told us about the problems they had when staff supported them. They told us that their visits were often interrupted by the staff having to respond to the phones that they carried. Staff used them to communicate with each other and the call bell system diverted calls through to these phones.

In addition, when there was no one based in the office, the front door intercom was also directed to the handsets carried by staff. This led to staff being called away in the middle of people’s allotted visits to deal with emergency calls and visitors. People felt that their care support time was wasted by staff needing to stop to answer the phone while they were working with them.

People using the agency told us how disturbing this was and that they never really felt that they were getting the carer's full attention and sometimes, that they were not getting the time they had paid for.

People also told us that at times staff arrived late and then needed to rush off and cut visits short. One person told us that they only needed assistance with a medical appliance in the morning to enable them to be able get themselves up and out of bed. They would like this task to be done early, otherwise the result was they got up late and sometimes missed appointments. They had been told that due to the pressure on staff at this time of the morning their request could not be met, they felt this was unfair as it impacted on the whole of their day.

We were also told that the manager was not approachable, did not always communicate effectively, was dismissive and was sometimes rude to people.

People who used this service told us that they were well supported and cared for. One person told us, "The staff here are very good. They are very helpful and pleasant. When they make notes about me they read it out whilst they write it". We found that people’s needs were assessed and care was delivered appropriately by caring staff.

The service actively monitored quality and learnt from incidents and accidents. The manager was on a leadership course and staff told us that the service was well led. We found that the service was taking measures to keep people safe where possible.

Overall this was an effective service that was responsive to people’s needs.